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Among total deaths in world, death due to RTA is ranked in 10 which include 13, 39,260 deaths. RTAs death is high in Zimbabwe accounting for 75.02 per 100,000 deaths, lowest in Micronesia i.e. 2.34 per 1, 00,000 deaths and Nepal accounting 20.13 per 100,000 deaths ranking 79 in the world (World Health Rankings). Every hour, 40 people under the age of 25 die in road traffic accident around the world and it is a second most important cause of death for 5-29 years old people [1]. Developing and underdeveloped countries accounted for 80% of these deaths [2]. Every year the lives of more than 1.25 million people are cut short as a result of a road traffic crash. Between 20 and 50 million more people suffer non-fatal injuries, with many incurring a disability as a result of their injury. Road traffic crashes cost most countries 3% of their gross domestic product (WHO). Globally, RTA is the eighth leading cause of death and is projected to rise to the top five by 2030. Approximately 90% of the estimated 1.2 million deaths from RTA occur in low-income and middle-income countries. In particular, countries in the Western Pacific Region and the South-East Asia Region of the WHO account for more than half of all RTI-related mortalities in the world. The mortality rate in the South-East Asia Region is 18.5/100 000 population and onethird of those deaths involve motorized 2–3 wheelers. About 30% of countries in this region have some policy to promote walking and cycling [3].

Non-fatal road traffic injuries account for 8.6 million Years Lived with Disability (YLD) worldwide. Reported prevalence of disability differs considerably between studies, depending on the characteristics of the casualties taken into account (e.g. injury severity), the duration of the follow-up and the type of disabilities that are taken into account. Self-reported prevalence of disabilities varies between 11% and 80% [4]. The majority of RTA was reported to occur among motorcyclist and pedestrians, in males, and in the age group of 20-14 years.

Globally, RTA is estimated to be the leading cause of death among young people aged 15–29 years, and second leading cause of death in 10–14 years and 20–24 years age groups. RTA depends on three factors, age, inexperience, gender. Adolescent are less able to assess risks, overestimate their abilities and more influence by their peers. Use of alcohol and drugs, not using a seatbelts, or wearing helmet, driving at high speed makes the adolescent more vulnerable. Young people are less able to perceive hazards, control the vehicle or make driver decision with confidence [5]. Increased number of vehicles, drink driving, inadequacies of the road, over confidence, distracted driving, ignorance, increased speed of the vehicles and child restraints are the commonest causes for increased road accidents (WHO).Various national and international researchers have found these as most common behavior of Road drivers, which leads to accidents (Transport Department of India,).

Nepal alone accounts for 73% of RTA burden of Disability adjusted life years (DALYs). Because of poor roads, ill-managed vehicles, improper rash driving, highway being the sites for the play of children and inadequate teaching of traffic rules as well as its inadequate incorporation in the school curriculum that leads to increased involvement of children in RTAs [6]. With no proper safety measures and lack of zebra crossings and overhead bridges for pedestrians, expanded road could become cause of deaths and injuries. There is a need to adopt a holistic framework to ensure transport system for all road users [7].

Transport modes that are linked to a relatively high prevalence of long-term disabilities are pedestrians and motorcyclists. Concerning age, prevalence of physical health impacts appears to be lower for younger casualties and concerning gender, women experience more physical and psychological consequences than men [4]. Many administrative bodies are refining and discovering more effective rules and regulations to decrease numbers of accidents and fatalities among adolescents as they are the most prone segment of the population [8].

Nepalese roads are one of the most dangerous in the world and chances of vehicle crashes are more than 100 times higher than in Japan and 10 times higher than in India. One person died in every accident in Nepal in the last year. According to Traffic Police data, more than 10,000 people have died because of road accident since 2006. Estimated mortality rate per 100 thousand populations in Bhutan is 14.4, in Thailand 25.4 and in India 16.8 where the figure in Nepal is 15.1. Urgent action is needed to achieve the determined target for road safety reflected in the newly adopted 2030 agenda for sustainable development (goal 3 and 11) and halving the global number of deaths and injuries from road traffic crashes by 2020 (WHO).

In 2017, WHO released Save LIVES a road safety technical package which synthesizes evidence-based measures that can significantly reduce road traffic fatalities and injuries? Save lives, a road safety technical package focuses on speed management, leadership, infrastructure design and improvement, vehicle safety standards, enforcement of traffic laws and post-crash survival. The package prioritizes and addresses the above risk factors , and provides guidance to Member States and its implementation to save lives and meet the road safety target of halving the global number of deaths and injuries from road traffic crashes by 2020 [9].

Objectives of the Study

General Objectives

To find out the knowledge regarding road traffic accidents among adolescents of a secondary school in Bhaktapur.

Specific Objectives

• To identify the knowledge regarding RTA among adolescents of a secondary school.

• To measure the association between adolescent’s knowledge level with selected variables.

Significance of the study

• The study findings will provide baseline information on knowledge of adolescent’s toward RTA.

• The findings might be helpful in formulating plan and programme for prevention of RTA to reduce the prevalence of RTA among secondary school adolescents.

• The study findings might be useful as reference materials to conduct similar type of study in the future.

Research Question

What is the level of knowledge regarding road traffic accidents among adolescents of a secondary school?

Variables

Independent Variables

• Socio-demographic variables: Age, Sex, Income status, Address

• System of traffic laws: Traffic signal, Pedestrian rule, driving rule

• Source of information (TV, Radio, Internet, Newspaper, Family members, School and Textbooks)

• RTA experience

• Driving experience

Dependent Variable

1. Knowledge regarding RTA

2. Operational Definitions

Knowledge

Knowledge refers to the factual information of knowing risk factors, consequences and prevention of road traffic accident. Each correct response will be scored as 1 on knowledge based questions. The mean score from knowledge portion questionnaire of all the respondents will be calculated and individual knowledge score will be interpreted as below:

Score                      level of knowledge

< mean score           Low Knowledge

≥ mean score          High Knowledge

Research methodology

Research Design

Descriptive and cross sectional research design

Research Setting

This study was carried out in Bagiswori, a government school which is situated in Taulachhe, Chyamhasing Bhaktapur, and ward no. 9 of Bhaktapur municipality. It lies in south east 1 km away from Kamalvinayek. It is running nursery to grade XII and offering 10+2 courses in science, management, education, humanities, civil suboverseer engineering programme. The school has a total of about 3,229 students from nursery to grade 12.

Study Population

In this study, the study population was students studying in grade 12, management faculty of Bagiswori Secondary School which was selected as per the purposive of the researcher.

Sampling Method

The sample was selected by probability random sampling technique. First of all, the sampling frame was developed by seeking information from principle of Bagiswori Secondary School. In a sampling frame, the total number of sections meeting the inclusion criteria was 8 sections. Among 8 sections, selection of 5 sections was done and then enumeration was done in selected sections.

Sample Size: 193

Inclusion Criteria

Both male and female students studying management faculty in grade 12 of Bagiswori Secondary School will be included.

Research Instrument

Part I: Questions related to socio-demographic characteristics Part II: Questions related to knowledge regarding road traffic accident, risk factors, consequences, and its preventive measures

The questions were in English language

Content validity of instrument was established by extensive literature review and seeking opinion of the research supervisor, subject teacher.

Scoring Criteria

In part II, 16 knowledge related questions were included. Every right answer was awarded as 1 marks and wrong answer was awarded as 0. Similarly, each correct answer of multiple choice questions was awarded as 1 and wrong answer awarded as 0. In this way the total score for knowledge related questions was 58. Mean score of knowledge of each respondent was calculated and score above mean is regarded as high level of knowledge and score below mean as low level of knowledge

Data Collection Procedure

After the research proposal was approved from the research committee of Maharajgunj Nursing Campus, official request letter was submitted to administration of Bagiswori Secondary School before the collection of data. Self-introduction and the objective of research study were explained and formal permission for data collection was obtained from college authority. Written informed consent was collected from each participant. An anonymous self-administered questionnaire was distributed to the students who were willing to participate in the study. The consent form filled up by the students was collected beforehand to maintain anonymity. The respondents were reassured for the confidentiality of the information. Participants were informed about the objectives of the research. It was explicitly explained that students' responses would have no influence on their evaluation. Students were given 20-25 minutes to complete the questionnaire. Participants completed the questionnaire in the presence of researcher in their own classroom. The data were collected over 2 week’s period from date July 9, 2018 to July 24, 2018.

Data Analysis Procedure

After completion of data collection, data was checked for completion. Data was coded, tabulated and organized. Data was entered in the statistical package for social sciences (SPSS) software program for analysis version 16. Data was analysed by using descriptive statistical methods where mean, median, standard deviation, percentage and frequency were calculated and inferential statistical method where chi square test was done (Table 1-11).

Table 1: Socio - demographic Characteristics of the Respondents’ N=193

Table 2: Respondents’ Experience of Driving and Road Traffic Accident.

*Multiple responses, n=193

Table 3: Respondents’ Knowledge Regarding Meaning of Road Traffic Accident.

*Multiple responses, n=193

Table 4: Respondents’ Sources of Information Regarding Road Traffic Accident.

* Multiple Response, n=193

Table 5: Respondents’ Knowledge Regarding High Risk of Road Traffic Accident.

* Multiple Response, n=193

Table 6: Respondents’ Knowledge Regarding Consequences of Road Traffic Accident.

* Multiple Response, n=193

Table 7: Respondents’ Knowledge Regarding Pedestrian Rules.

* Multiple Response, n=193

Table 8: Respondents’ Knowledge Regarding Preventive Measures of Road traffic Accident.

* Multiple Response, n=193

Table 9: Respondents’ Knowledge regarding Minimum Legal Age for Getting Driver’s License and Driving Rules.

* Multiple Response, n=193

Table 10:  Respondents’ Level of Knowledge on Road Traffic Accident.

Table 11: Association between the Respondents’ Level of Knowledge and Selected Variables.

P value*: significant at <0.05

Discussion

In this study, nearly half of the respondents (45.6%) had low level of knowledge regarding RTA. This finding is comparatively higher to the finding of the study conducted among students of medical and nursing science by Sharma & Saini in which 23.3% students had low level of knowledge regarding RTA.

Regarding driving experience

More than half (61.1%) of the respondents had driven a vehicles while only 38.9% had not driven a vehicles. Among the respondents who have driven a vehicle majority (59.32%) had experience of driving a vehicle of less than 1 year followed by 18.7% of 1-4 years, 5.2% of 5-9 years and only 1% experienced more than 9 years. This findings is supported by the study [10] in which among total 353 respondents, 58.4% have driven a vehicles. Similarly, this findings is not supported by the study [11] which shows that the majority of the participants 45% had no experience, followed 22.9% had less than or equal to two years of driving experience, then more than two years 32.1%. Similarly, this study were concordance with the study [12] which was conducted in India in which analysis of the drivers met with the accident was done on basis of their driving experience. Maximum drivers (9.8%) were having less than 1-year experience followed by 6.5% drivers who had experience between 1 and 2 years. The variation among the studies in terms of sample and settings can be attributed for differences on findings.

Regarding RTA experience

Majority (58.0%) of the respondents had experienced RTA. Among them, 85.71% had experienced motorcycle accident followed by 71.43% bicycle accident, 14.28% bus accident and 10.71% truck accident. This finding is not contradictory to the study [14] in which only 35.1% had experienced a motorcycle accidents. Similarly, this finding are quite different from the findings of a similar study [15] which shows that more than half of the students 64.2% had not been involved in road traffic accident. Similarly, while discussing about the RTA experience, according to study (Thapa) highest (77.9%) number of road causalities is happening to the pedestrians followed by motorcycle riders. Variations among the findings might be because of the sample difference and methodological differences.

Concerning about the knowledge about RTA, all of the respondents had heard about RTA. Asking about the meaning of RTA; majority (94.3%) answered RTA as collision between moving vehicles, 92.7% answered collision between moving vehicle and moving person, 86% answered collision between moving vehicle and stable person and 81.3% answered collision between moving vehicle and stable vehicle. These meaning is supported by Javel & Lisha in which Road Traffic Accidents are defined as an accident, which takes place between two or more objects, one of which must be any kind of moving vehicle.

Regarding the Respondent’s Sources of Information Regarding Road Traffic Accident

Majority (93.8%) of the respondents answered that internet is main source of information of RTA, followed by 87.6% by television and radio, 83.4% by newspaper, 65.8% by school and textbooks and 60.6% by family members. This study is not concordance with the study [9] in which schools and textbooks (83.83%) played a major role in making students aware which is higher in comparison to the present study; family member (9.69%); television and newspaper (8.24%) which is much lower in proportion to the current study.

Regarding the question regarding risk factors of road traffic accident

All most all (95.9%) of the respondents answered driver’s error and negligence, drink driving as a risk factor for RTA, 91.2% answered lack of awareness on traffic rules, 80.3% answered age factor, 72.5% answered violence of traffic rules, 69.4% answered poor vehicle condition, 69.4 answered pedestrian error and 60.6% answered peer influence. This study resembles with the study, in which out of 390 students, 73.5% mentioned fault of driver and 41.81% mentioned carelessness by traffic police signs. Similarly, this study concordance with study (Gopalakrishnan, 2012) 78.5% of RTA is due to fault of driver, fault of pedestrian (02.2%), defect of motor cycle (01.8%), defect of the road (0.13%), fault of cyclist (01.2), weather condition (0.08%). Similarly, this result has consistency with the findings in a study [16] in which 18.8% identified driver error and negligence, 1.8% answered violence of signals, 2.7 answered vehicle condition, 15.1% answered fault of pedestrian. But, the findings is opposed by study [17], which shows that the reasons for accidents is 71.6% due to driving over speed limits, 5.6% due to pedestrians on the street, 8.6% due to poor driving skills, 7.7% due to bad roads, 2.8% due to failure to follow traffic signs, 0.5% due to poorly maintained vehicles.

In this study, among total respondents who answered driver error and negligence drink driving as a cause of road traffic accident, majority (93.8%) answered that high speed as a driver’s error whereas 79.8% answered driver’s non-compliance with traffic rules and regulations, 73.1% answered driver’s lack of awareness about traffic rules and regulations and 71% answered no experience. This is not supported by the study in which among 120 students of a university students in Taif, KSA, 50% of respondents answered high speed as a driver’s error in RTA, 6.6% driver’s lack of awareness of traffic regulations and laws, 10% driver’s noncompliance with traffic rules and regulations. Similarly in a study conducted by Osman and Ahmed, 2014), answered high speed as the cause of RTA.

Regarding the respondent’s knowledge in high risk age group for RTA

Majority (57%) answered adolescent as a high risk age group which is correct response. This finding is supported by the findings in the study [5] where majority of the driver’s (49.7%) were in the age of 18-19 years. Similarly these is not supported in study [8] which presents that around 75% of RTA victims were between 15-49 years old.

In this study, majority of the respondents (54.9%) answered trucks as a high risk vehicle for road traffic accident, followed by 40.4% motorcycle, 4.1% buses and 0.5% cars. These findings is supported by study (Sharma, Mishra, Ahmed & Chand, 2015) which reflects that among the vehicles involved in accidents, trucks and tipper were at the top position (27%), followed by two wheelers (25%). But, this result is not supported by the study [18] in which out of 1257 victims of road traffic injuries, 60% were motorcycle users and in a study conducted by Montazeri shows that the rate of motorcycle related injuries (per 1000 registered vehicles) was seven times higher than that resulting from cars or small trucks.

Regarding the respondent’s knowledge regarding consequences of the RTA

Majority (92.2%) of the respondents answered fractures as the physical consequences followed by 91.7% answered death, 87% answered head injury and 72.5% answered lacerated injury. These findings was contradictory to the study [19] in which majority of the victims had lacerations (38.4%), followed by muscle injuries accounting 32.3% and head injuries, fractures, spinal cord injuries,functional impairment, death is 15.2%, 31.3%, 7.1%, 14.1% and 11.1% respectively. Mortality was found in 11% of cases and 14% of cases have different types of functional impairments such as difficulty in walking and confused mental state. In a study conducted by Manna shows that out of 206 RTA victims; 68.4% had fractures which lies 2nd position in current study, 28.6% had head injury and 11.6% had lacerated injury which is lower in proportion to the current study. The variation among the studies in terms of sample and settings can be attributed for differences on findings. Concerning about the knowledge of respondent’s in emotional consequences, majority (90.7%) of the respondents answered fear of travel followed by 73.1% answered fearful, 68.4% answered depression, 52.8% answered sleep difficulties. These findings was also not supported by the study [20] head injury was found in 43.33% cases and its associated fatality rate was 90.90% Regarding the mental/ emotional consequences; 65.4% answered fear of travel, 47.4% answered depression, 39.7% answered fearful and 31.4% answered sleep difficulties. This is very high in proportion to the study [7] where 39% had travel anxiety, 23% had depression, 14% had fear and 17% had sleep difficulties.

In this research, majority (94.3%) of the respondents answered RTA can be prevented by following traffic signals followed by 87% answered constructing proper roads, 84.5% answered strong policy formulation, 83.9% answered reduction of speed and 75.1% answered provision of paths for pedestrians. Regarding the knowledge regarding traffic law of Nepal, majority (85.5%) of the respondents had answered traffic laws of Nepal should be punished for those who do not follow it. Followed by 83.9% answered implemented strictly and 77.2% answered strongly formulated. Similar type of findings was reported by the study (Bhattarai) in which 359 stated RTA can be prevented using different measures such as 82.7% following traffic rules, 50.4% construction of proper roads and 33.4% provision of footpaths for pedestrian.

Regarding the pedestrian rule

Majority (93.8%) of the respondents had answered that pedestrian rule includes using zebra crossing followed by 89.1% answered using overhead bridge and 83.9% answered walking through the footpath. Among total respondents, almost all (99.5%) had answered that pedestrian should cross the road from zebra crossing followed by 89.1% answered overhead bridge, 49.2% answered subway. This finding is supported by the study in which 95% were aware of the rule that the pedestrian must use the zebra lines to cross the road and 45% of total respondents knew the rule that pedestrians must walk only through right side. Concerning the question related with crossing road by the pedestrians, among total respondents, majority (79.8%) had answered pedestrian should cross the road when traffic signal is steady green human figure, which is correct answer. The findings is low proportion to the study [21]in which out of 1051 respondents all were aware about red and green signal and about yellow colour 86.9% were aware.

Regarding the given traffic symbols

Almost all (99.5%) of the respondents had identified no parking symbol, followed by 99% identified no horn zone, 94.8% identified speed limit, 93.8% identified bus stop, 88.6% identified right turn, 81.9% identified pedestrian prohibited, 76.2% identified danger/ warning sign and 72.5% identified zebra crossing. Similar study (Mirza & Daud, 2013) study was conducted in Tulspura, Lahore. In these study, the knowledge level of study participants regarding road signs was considerably high especially in case of what do the traffic signal lights indicate (94%), not to horn (79%) zebra crossing (95%) and pedestrian prohibited (75%).

Regarding knowledge regarding minimum legal age for getting driver’s license

Majority (68.4%) of the respondents knew about the legal age for getting driver’s license. Among the respondents who answered about knowing legal age, only 43.18% answered correctly as 18 years for getting driver license. This result is not supported by the study (Thomas, 2010) which shows that nearly 96.7% know the age for acquiring a major driver’s license.

This study shows that almost all (95.3%) of the respondents answered that driver should not talk in phone during driving, followed by 93.3% answered use seat belt in 4 wheeler of helmet in 2 wheeler, 92.2% answered follow traffic signals, 87.6% answered avoid drink driving, 85.6% answered give space for emergency vehicles and 67.9% answered us low beam light in night. These findings were supported by the study shows that 80% of the respondents answered driver should wear helmet and 83.48% answered driver should not use mobile while driving. This is also supported by the study, in which 83% had knowledge about giving space for emergency vehicles and 35.1% knew the use of low beam light in night.Among total respondents, majority (94.8%) had answered that driver should stop vehicle when traffic signal is red. This is supported by study in which all of 1051 respondents were aware about red signal.

Discussion between the selected independent variables with depend variable

In this study, there is significant association between the selected independent variable age and dependent variable knowledge i.e., P value 0.001 but there are no any significant associations between address and income status with knowledge level. This finding is supported by the study in which gender is statistically significant with knowledge (P value- 0.015).

Regarding the association between the parent’s education status and knowledge level, there is significant association between father’s education status i.e., P value 0.030. This finding is supported by study which there is significant association between father’s educational status. But there is no significant association between mother’s education statuses with the knowledge level i.e. P value 0.692. This finding is reverse with the study in which there is significant association between mother’s educational status with knowledge level (chi square value 9.80 and 14.83 at P value <0.05 respectively).

Conclusion

On the basis of study findings, it is concluded that more than half of the adolescents tend to have adequate level of knowledge regarding RTA. Adolescent’s level of knowledge tends to vary with sex and father’s educational status. However their level of knowledge does not vary with driving experience and RTA experience.

Limitations

As the study was descriptive cross sectional design with nonprobability purposive sampling technique and limited only to grade 12 of management faculty in Bagiswori Secondary School, Bhaktapur, so it cannot be generalize. Being probability random sampling technique in which random selection of 5 sections will be done from 8 sections and after that census method was applied in that selected sections. The study was limited to 193 samples.

Implications

The findings of this study will be source of reference or baseline to future research on RTA and related studies. Similarly, the findings might be helpful for the traffic police to organize awareness program for the prevention of RTA. The study might be helpful to parents, teachers and nurses to provide knowledge about RTA and its prevention.

Recommendations

It is recommended to conduct regular awareness campaign programs about its prevention to increase the knowledge level of the adolescents. A comparative study need to be carried out as to find out difference on the knowledge on different level of students. A replication of the present study can be conducted in different areas covering larger sample size to draw generalization with observation technique to assess level of knowledge.

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